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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018016
Report Date: 07/12/2024
Date Signed: 07/12/2024 04:22:20 PM

Document Has Been Signed on 07/12/2024 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PEACE OF MIND PRESCHOOLFACILITY NUMBER:
198018016
ADMINISTRATOR/
DIRECTOR:		SIMONE JONESFACILITY TYPE:
850
ADDRESS:240-250 S. PARCELS ST.TELEPHONE:
(909) 629-0600
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 8DATE:
07/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Director Jerry LewisTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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At 10:00am (LPA) Licensing Program Analyst Stephanie Li conducted an unannounced annual inspection. Upon arrival LPA met with Teacher Jarbari Tate. Teacher called Director to notify him that licensing was present. There were 8 children present upon arrival and 1 teacher. Upon arrival, LPA observed teacher walk children back from the park that is across the street. Center also has an infant license but currently has no infants enrolled. Hours of operation are Monday-Friday 6:00am-6:00pm. Director Jerry Lewis arrived to facility by 10:45am.

All areas identified on the Facility Sketch were inspected. The facility consists of 5 classrooms, 3 outdoor areas, and 4 bathrooms. Children and staff names were recorded. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. All children were observed to be under active/visual supervision of a teacher during the tour.

Licensing staff observed disinfectants, cleaning solutions, medication and other items that are dangerous to children were not accessible to children. Classroom furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. Napping equipment (mats) and bedding were inspected for good condition, appropriate storage, and cleanliness. Center has a washer and dryer and wash their linens as needed or daily. LPA advised for children’s bedding used for the week shall be stored separately so that no child’s bedding will be touching another’s. Storage for children's belongings were inspected. All toilets and washing facilities are in safe and sanitary operating conditions. First Aid supplies are available. Drinking water was readily available indoors. The office is used as an isolation area when a child is sick, they place a mat down for an ill child to rest and the restroom in the hallway will be used if needed.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEACE OF MIND PRESCHOOL
FACILITY NUMBER: 198018016
VISIT DATE: 07/12/2024
NARRATIVE
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Licensing staff observed all required forms/publications to be posted by the front entrance. LPA advised to include in the schedule of activities specific details regarding their park field trips. LPA also advised that their waiver to utilize the park as a playground was rescinded. Facility is still allowed to take field trips to the park however, parents need to be well informed regarding each trip and permission slips need to be obtained. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Facility provides am and pm snacks and lunch. LPA advised director to label expiration dates on packages that have been removed from the original box. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects, and rodents.

Licensing staff observed the required 2A10BC fire extinguisher indicates fully charged and was serviced on 04/30/24 on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Facility has a functioning carbon monoxide and smoke detector that meets statutory requirements. Director states there are no weapons, firearms, or bodies of water on the premises. The last disaster drill was conducted in July 2, 2024. Reminded director disaster drills must be conducted at least every six months.

At 11:45 am, licensing staff reviewed the outdoor play area. The playgrounds equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Drinking water is brought outside with the children when they go out.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed that 7 out of 8 children were not signed in correctly by parents. LPA observed that 4 out of 8 children did not have sign in sheets available in the binder. A citation is being issued, see LIC809D. LPA observed director correct sign in sheets during the visit.

Licensing staff reviewed staff records documented on the LIC 859. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Staff present had proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof against TB. One staff was missing proof of measles and pertussis. Citation being issued see page lic809D.


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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEACE OF MIND PRESCHOOL
FACILITY NUMBER: 198018016
VISIT DATE: 07/12/2024
NARRATIVE
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Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEACE OF MIND PRESCHOOL
FACILITY NUMBER: 198018016
VISIT DATE: 07/12/2024
NARRATIVE
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The facility has completed lead testing and is in the process of remediating lead exceedances. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.


Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.



Exit interview conducted, report was reviewed, and appeal rights were given to director Jerry Lewis.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2024 04:22 PM - It Cannot Be Edited


Created By: Stephanie Li On 07/12/2024 at 03:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEACE OF MIND PRESCHOOL
FACILITY NUMBER: 198018016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(1)(b)

(1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in four out of eight children did not have sign in/out sheets available, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2024
Plan of Correction
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LPA witnessed Director created and print sign in/out sheets for each child that was missing them. Director will print sign in and out reminders and place in front of sign in binder.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2024 04:22 PM - It Cannot Be Edited


Created By: Stephanie Li On 07/12/2024 at 03:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEACE OF MIND PRESCHOOL
FACILITY NUMBER: 198018016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)

(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of three staff did not have records of measles or pertussis immunization, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2024
Plan of Correction
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Per licensee, she will obtain immunizations records and email to LPA by 7/26/24. LPA witnessed her call doctors office requesting records.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024


LIC809 (FAS) - (06/04)
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